臺灣學生自殺身亡之發生率、特徵與相關因素

Abstract

研究背景：自殺是全球兒童及青少年重要的公共衛生問題。近年來，許多國家的兒童及青少年自殺率持續上升。本研究旨在探討臺灣學生自殺率與同年齡層之一般族群的自殺率差異，以及臺灣學生自殺身亡之特徵和相關因素在性別與年齡的差異。 研究方法：本研究分析2018年至2023年間臺灣學生之自殺資料，學生自殺身亡報告來自教育部校園安全及災害事件通報系統。計算學生各年齡層自殺率以及同年齡層之一般族群自殺率，並利用卜瓦松回歸 (Poisson Regression) 比較6-29歲學生與一般族群的自殺率比 (Standard mortality ratio [SMR], 95% confidence interval [CI])。使用卡方檢定或費雪精確檢定比較學生自殺之特徵 (方法、地點、月份) 和相關因素在性別、年齡的差異，並使用邏輯斯迴歸估算不同個案的自殺相關因素在性別、年齡間之勝算比 (odds ratios, ORs) 與95%信賴區間 (95% CI)。當比較自殺率的每月變化時，計算每月的自殺率 (monthly rate) 與SMRs。 研究結果：2018-2023年間，共有622位學生自殺身亡 (51%為男性)。19-29歲年齡組佔總體學生自殺比例的60%，其中55%為大專校院學生。23-29歲女性學生的自殺率高於同年齡層之一般人口 (SMR = 1.46, 95% CI 1.13-1.87)。學生最常見的自殺方式為高處墜落 (48%)，其次為上吊或窒息 (32%)，以及燒炭 (12%)。女性學生 (55%) 及6-18歲之年輕族群 (59%) 的自殺方式以高處墜落為主，而男性學生 (分別為41%與37%) 及19-29歲之年長族群 (分別為40%與35%) 則是高處墜落與上吊或窒息的比例相近。自殺學生的戶籍地大多位於都市地區 (74%)，且學生自殺多發生於校外地點 (83%)，其中以家中最為常見 (51%)。男性學生十月的自殺率高於平均 (SMR = 1.41, 95% CI 1.01-1.98)，而女性學生則在三月的自殺率最高 (SMR = 1.93, 95% CI 1.43-2.60)。學生自殺的常見相關因素包括精神疾病 (40%)、家庭關係問題 (33%)以及學業相關問題 (25%)。其中，性平事件與女性學生的自殺呈現最強的關聯 (OR = 8.72，95% CI 1.99-38.25)，其次為自我傷害史 (OR = 2.48，95% CI 1.59-3.87)、精神疾病 (OR = 2.02，95% CI 1.46-2.79)以及家庭關係問題 (OR = 1.55，95% CI 1.11-2.17)。年長族群較年輕族群較少出現家庭關係問題 (OR = 0.40，95% CI 0.28-0.56)。相較之下，經濟、職場與居住問題則與年長的族群自殺呈現最強關聯 (OR = 5.90，95% CI 2.30-15.15)，其次為人際疏離或孤獨 (OR = 4.11，95% CI 1.70-9.91)，以及精神疾病 (OR = 1.96，95% CI 1.40-2.76)。整體而言，只有39%及42%的學生在自殺前曾使用過校內及校外心理輔導資源。 結論：此研究結果強調發展具年齡與性別敏感度之自殺防治策略的重要性，未來應強化學生求助行為、早期識別心理健康問題、提升心理健康服務的可近性，並針對高風險族群提供心理支持，作為自殺預防工作的關鍵要素。

Background: Suicide is a major public health concern among children and young people worldwide. The suicide rate has been rising among children and young people in many countries in recent years. The study aimed to investigate the incidence of suicide in students compared with the general population and the sex and age differences in the characteristics and related factors of student suicide in Taiwan. Method: The study analyzed data for student suicides aged 6-29 years from the student death reports compiled by the Campus Security Report Center, the Ministry of Education, Taiwan (2018-2023). The suicide rates for students were compared to those in the general population by calculating the standard mortality ratio (SMR) and their 95% confidence intervals (CIs) using Poisson regression. Sex and age differences in the characteristics (method, location, month of suicide) and related factors of student suicides were analyzed using the Pearson’s chi-square test or Fisher’s exact test, where appropriate, and odds ratios (ORs) estimated using logistic regression. When examining the monthly variations in suicide, the monthly rates and SMRs of suicide were calculated. Results: In 2018-2023, there were 622 student suicides (51% males) in Taiwan. The 19-29-year-old group accounted for 60%, and 55% were college and university students. The suicide rate of female students aged 23-29 was higher than that of the general population in the same age group (SMR = 1.46, 95% CI 1.13-1.87). The most common method of student suicide was falling from a height (48%), followed by hanging or suffocation (32%), and charcoal burning (12%), while sex and age differences were found. Falling from a height was the leading method in female students (55%) and the young group aged 6-18 (59%) while falling from a height and hanging or suffocation were similarly common in male students (41% and 37%, respectively) and the older students aged 19-29 (40% and 35%, respectively). The registered residence of students who died by suicide was mostly in urban areas (74%). Most student suicides occurred at off-campus locations (83%), with home being the most common location (51%). Male and female students showed a higher-than-average monthly suicide rate in October (SMR = 1.41, 95% CI 1.01-1.98) and March (SMR = 1.93, 95% CI 1.43-2.60), respectively. The common related factors of student suicide included mental illness (40%), family relationship issues (33%), and academic-related issues (25%). Sexual assault, harassment, and bullying incidents (OR = 8.72, 95% CI 1.99-38.25) showed the strongest association with female student suicide, followed by history of self-harm (OR = 2.48, 95% CI 1.59-3.87), mental illness (OR = 2.02, 95% CI 1.46-2.79), and family relationship issues (OR = 1.55, 95% CI 1.11-2.17). Family relationship issues were less common among older students aged 19-29 than among younger students aged 6-18 (OR = 0.40, 95% CI 0.28-0.56). On the other hand, financial, workplace, and housing issues (OR = 5.90, 95% CI 2.30-15.15) showed the strongest association with older students aged 19-29, followed by social isolation, withdrawal, or loneliness (OR = 4.11, 95% CI 1.70-9.91), and mental illness (OR = 1.96, 95% CI 1.40-2.76). Overall, only 39% and 42% of students had prior contact with on-campus counseling services and off-campus services before suicide, respectively. Conclusion: Findings underscore the need for age- and sex-sensitive suicide prevention strategies for students. Enhanced help-seeking, early identification of risk, increased access to mental health services, and targeted support for high-risk subgroups are essential.